Project Summary This is an application for the renewal of a K24 mentoring award for patient-oriented research (POR) from Anne Cappola, MD, ScM, Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania (Penn). The candidate has had a strong record of mentorship, leadership, and research productivity during the initial award period. Her research program encompasses POR studies at the intersection of endocrinology and geriatrics. The scientific goals of this proposal are to investigate the age- specificity of the cardiovascular risks of mild subclinical hypothyroidism and to examine thyroid stimulating hormone (TSH) testing and levothyroxine prescribing patterns in older individuals. These studies are required to support a change in the upper limit of the TSH reference range for individuals aged 65 years and older. This change would improve the health and reduce health care costs for millions of older Americans through prevention of unnecessary prescription of thyroid hormone treatment, reduction in excessive TSH monitoring, and avoidance of iatrogenic thyrotoxicosis. The mentoring goals of this application are to support the candidate?s six current K-award mentees? transition to R01 funded independence and to engage a new generation of Penn fellows and junior faculty to conduct POR in aging. The career development goal of this application is to support the candidate?s professional development and program building in clinical investigation. This will be achieved through focused learning about biomedical informatics, engagement in Penn?s CTSA to enhance lifespan research, and ongoing leadership to promote the visibility of aging research in the endocrine community. The institutional environment for clinical and translational science at Penn is outstanding, and the proposal integrates multiple programs from Penn?s CTSA. The Department of Medicine at Penn has made a substantial commitment, including protected time and dedicated space, toward the candidate?s sustained success as a patient-oriented researcher responsible for training a new generation of junior investigators who conduct POR in older participants. Renewal of this application will allow the candidate to cement the programmatic gains achieved during the initial award period and to assure their sustainability after the renewal has completed.